Artery disease is the largest threat that people with diabetes face. Artery damage can lead to heart attack and stroke. People with diabetes may have poor blood flow in the legs. When this problem is severe, sometimes people with diabetes need amputation of a toe, foot or leg.

For many diabetics, someone in the family has had a heart attack or stroke at a young age. This family history increases the risk of heart disease. Having diabetes increases the risk, too. Diabetics are two to four times more likely than others to have a heart attack or a stroke.

Why are diabetics so prone to artery disease? It's partly because they are more likely than others to develop health problems that affect the heart. These include high blood pressure, excess weight and high cholesterol. The result is an unfortunate "package deal." The combination greatly increases the risk of artery disease.

Having several risks for heart or artery disease is known as the metabolic syndrome. This syndrome is a powerful health threat. (It's also called syndrome X or insulin resistance syndrome.)

Metabolic syndrome is very common among diabetics. If you have type 2 diabetes, you are more likely to have each of the following risks. It is common for a person with diabetes to have all of them.

Insulin resistance — Many researchers suspect that insulin resistance may cause all of the other risks in this list. In many people, insulin resistance shows up first. It is the cause of type 2 diabetes. Some medicines for diabetes reduce insulin resistance. These drugs may prevent artery disease better than drugs that lower blood sugar in other ways.

High blood pressure — More than 60% of people with type 2 diabetes have high blood pressure, compared with much lower rates in the rest of the population.

Cholesterol problems — Many people with type 2 diabetes have the same cholesterol pattern. They have a high triglyceride level and low HDL cholesterol level. The other cholesterol type is LDL (the "bad" cholesterol). People with diabetes often have an especially dangerous form of LDL. It is made up of small, dense molecules. This type of LDL makes arteries highly vulnerable to blockage by a blood clot.

Obesity — It is very risky to have excess fat in the belly or around organs in the belly. A healthy waist size for a man is no more than 40 inches. A woman's waist should be no larger than 35 inches. Some diabetics have a normal waist size but have fat deposits in organs such as the liver.

Blood-clot risks — Blood chemistry affects blood clotting risk. One chemical in the blood is called plasminogen activator inhibitor 1. Most people with the metabolic syndrome have high levels of it. Doctors don't routinely test for it. However, it is known to promote formation of blood clots. A blood clot is what triggers a heart attack or a stroke.

Exaggerated effects of smoking — Smoking is even more dangerous for people with metabolic syndrome. Smoking multiplies your risk of artery disease. If you have most or all of the risks above, smoking will further increase your risk of a heart attack or early death by about 40%.